Once a woman finds out she is pregnant, the most common question that follows
is, “What is labor really like?” JustMommies got together with Liz
Baker-Wade, a labor and delivery nurse, childbirth educator, and the Founder of
Birth and Beyond in Santa Monica. Liz gave us the 411 on what to expect when going
into labor.
JustMommies: This is definitely a hot topic. New parents of
a ton of questions about labor. As a mom, what can I do to give myself an easier
labor and a better experience overall?
Liz: One of the most important things is to understand how
we labor women in our culture. In other cultures, women are up, they use motion
and rhythm, they are in warm water… but in our culture, we tend to put
women to bed early in labor. Does that help? Not really, because gravity helps
move the baby through the pelvis. When we put a woman to bed- we increase the
likelihood of a long labor, needing a lot of intervention. Lying down inhibits
the process of natural labor. As long as you can be up, using motion, using
rhythm, sitting on a birth ball, swaying, on all fours ~ the better.
JustMommies: Does labor really hurt?
Liz: Yes, labor hurts. It does. Now it’s an interesting
thing, I’ve been taking care of laboring women for years. How each woman
experiences labor, has a lot to do with her experience with pain. Some women
have a long history with pain. They may have had chronic migraines, back pains,
broken bones. They’ve sort of learned how to emotionally, physically and
psychologically manage their pain. Therefore, they deal with pain in a different
way than a woman who has never had a day’s pain in her life. A women who
doesn’t deal with pain very often, might go into a panic mode. It’s
the fear, combined with the pain, that makes labor seem so overwhelming and
we have to talk that woman off the ledge and let her know that this is normal.
We call it “discomfort” or “birthquakes”… but
basically, labor pain hurts.
JustMommies: Let’s put labor into perspective. How does
it feel?
Liz: For me, it was like really severe period cramps. Now in
the beginning of labor, women often experience cramps and it’s no big
deal. But when they start adding up- it gets a little bit more formidable, a
little more intense. You realize that it may take all your concentration and
focus to breathe through it. I think labor should be taken in 15 minute increments.
Let’s do this and see how this goes, and then we’ll move on and
see how you feel again in 15 minutes.
JustMommies: What would you say are the most popular birthing
methods?
Liz: Some kind of prepared childbirth method. At Birth and
Beyond, I teach a basic prepared childbirth class that includes relaxation,
birth ball work and a massage technique for the dads to do to the mothers. It’s
great. The Bradley method of husband-coached, natural childbirth is also very
popular. Teachers of the Bradley Method believe that with adequate preparation
and education, along with help from a supportive coach, most women can give
birth naturally without drugs or surgery. HypnoBirthing is another popular birthing
method. Parents actually work with tapes and audio. They are teaching themselves
to get into a hypnotic, relaxed state to deal with the pain of labor.
JustMommies: What about water births?
Liz: Unfortunately, you will not find water births in a conventional,
urban hospital… probably having to do with space, cleanliness, and liability.
Personally, I would love every woman to be able to labor in warm, bubbly water.
Water births are perfectly safe. They definitely have been associated with decreased
pain because warm water is a muscle relaxant. Babies do not drown. They won’t
take a big breath of water until they come to the surface. Isn’t that
nice?
JustMommies: Walk us through the process of labor.
Liz: The process of labor is a very individual thing. Everybody
wants me to tell them what labor is going to be like and I always say the same
thing year after year. The predictability about how labor feels to one woman,
how it’s going to go, or how long or short it’s going to take is
very poor. Some women experience distinct signs of labor, others do not. Signs
that may indicate the beginning of labor include: lightening (the process of
your baby settling or lowering into your pelvis), passing of the mucus plug,
contractions, breaking of the bag of water, and effacement and dilation of the
cervix. Generally, it’s a big waiting game, but going into a natural labor
is the next step. Labor contractions usually cause discomfort and a dull ache
in your back and lower abdomen, along with pressure in the pelvis. Here’s
my rule of thumb, you may be in an early labor pattern for 24 hours. That means
completely manageable labor. Your contractions are consistent, but they are
not painful enough to make you stop talking, you are not teary, you are not
having to breathe through it. Basically, you are able to function in your daily
activities. Try to keep busy. Garden, go to lunch, take walks, bake something…
there is no reason to go to the hospital unless you feel that you need help
or you are having consistent, predictable contractions that are so painful,
you cannot speak through them. If you are lucky enough to have a Doula coming
to your home, you have that trained extra person who is going to be able to
keep you at home longer. Why would you want to stay at home longer? Because
once you get to the hospital, you have that cascading, effective intervention.
Sometimes, it’s the fear of being in pain at home that brings the mother
to the hospital too early. At the hospital, the nursing part of labor begins.
We check the cervix to look at effacement, dilation and where the baby is in
the pelvis. We take the mother’s vital signs, we obtain blood samples,
urine samples and we put the baby on the monitor. Hospitals are very monitor
centric. We are watching the baby and we take care of our moms in labor according
to what the baby is telling us on the monitor and the mother’s contraction
pattern. Ten centimeters is the golden ticket, but you can be ten centimeters
and four hours away from pushing time. The baby needs to come through the pelvis
and the baby’s head needs to mold and rotate down into the birth canal.
Then it’s time to push.
JustMommies: During this process, can you eat… drink…
and go to the bathroom?
Liz: If you are in your home laboring, you would eat and drink
adequately. Once you get to the hospital, we cut you off from food, which is
the complete antithesis of what the contracting uterus needs. Why do we do this?
We are worried about liability. If we have to rush you off to a C-section, nausea
and vomiting, etc. Therefore, once you are in the hospital, if you are in active
labor (greater than four centimeters), if you are on pitosin, if you have an
epidural… you are cut off from everything other than ice chips, and the
occasional popsicle that your nurse slips you.
JustMommies: How does an epidural work?
Liz: Let me start by saying, I’m not anti-epidural, as
I had one myself. The epidural is a wonderful form of pain relief, but it doesn’t
come without its consequences and problems. So, it’s not to be taken lightly.
The epidural is a vasodilator. That means it dilates the blood vessels and dilating
the blood vessels also relaxes muscle. But what do I want the uterus to do in
order to have adequate labor? I want the uterus to contract. So, if you have
an epidural and you are wanting your patient to contract- then you are fighting
against it. The epidural given in an early phase of labor almost guarantees
a long, cascading effect of some kind of intervention. You are confined to bed,
which now means that using gravity and motion and rhythm is out of the question.
The patient is positioned in a way to open the spinal spaces, either leaning
forward or laying on your back. The anesthesia that is put on the skin is litacane.
Once the litacane takes effect, the doctor then inserts the epidural needle
into the epidural space, not into the spine. A catheter is passed through the
epidural needle, left in place and the needle is taken out and thrown away.
It’s very important that moms understand there is no needle in your back
for the duration. This whole process may sting a little, but most women say
compared to the labor pains- bring it on! In my class, I try to discourage use
of epidurals in the early phases of labor. Again, the earlier you have an epidural,
the earlier that cascading effect of intervention happens. It’s like a
train coming out of the station. This train (your labor) now has momentum and
at least the epidural is not working so much against you.
JustMommies: How can you better prepare for labor?
Liz: Good nutrition and being in good physical condition. There
is a lot of pregnancy yoga going on nowadays. Conditioning is important. The
problem is, some people want to START getting in shape when they become pregnant
and that’s not recommended… except for walking and light weights.
You don’t want to start a hard, driving regime of exercise in your second
trimester because you’ll be more prone to injury. I definitely recommend
a good, prepared childbirth education class as well. Important questions to
ask your teacher: How long have you been teaching? What are your philosophies?
Where do you get your information? I would love a teacher who has spent time
in labor and delivery. It’s also important to prepare for birth in your
class (birth ball work, massage, relaxation techniques). It’s not enough
to hand someone a piece of paper and tell them to practice at home. There are
a lot of people out there, childbirth educators, doulas, nurses, who are waiting
to help women have a good experience. Remember, labor is doable. One of the
things we know for sure is that women keep having babies. If it were that horrible,
we wouldn’t be having more children. Labor takes research, it takes some
courage, it takes a sense of humor. You are leaking fluid, your breasts are
filling up, your labor pain hurts… so if you can, dig deeply for a sense
of humor. It will help. Plus, the big pay off at the end ~ you have a beautiful
baby in your arms!
For more information on Liz Baker-Wade, check out www.birthandbeyond.net.
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